Rheumatism is any painful disorder affecting the locomotor system including joints, bones, muscles, connective tissues and soft tissues. The speciality of medicine which deals with Rheumatism is called Rheumatology. A Rheumatologist is an internist or pediatrician who has received training in the diagnosis and treatment of arthritis and other musculoskeletal diseases. Many of these diseases known to be disorders of the Immune system and Rheumatology is increasingly the study of Immunology. They are also referred to as autoimmune diseases.

What are the diseases included?

There are more than 200 types of these diseases, including connective tissue disease [Rheumatoid arthritis(RA), Systemic Lupus erythematosus (SLE) etc], spondyloarthropathy (diseases affecting vertebrae), degenerative joint diseases(osteoarthritis), crystal related diseases (Uric acid related - gout), low back pain, osteoporosis, and enthesis. Some of these are very serious diseases causing mortality and morbidity that can be sometimes difficult to diagnose and treat.

What are connective tissue disorders?

Connective tissue diseases include RA, SLE, Scleroderma, Sjogren's syndrome, myositis and mixed connective tissue disease (MCTD). In addition to these, there may sometimes undifferentiated forms where they exactly do not fall into the one specific group is called undifferentiated connective tissue disorders (UCTD).

What is Rheumatoid arthritis?

RA is the most common cause of arthritis affecting mainly females of reproductive age group. RA is a crippling disease that causes pain, swelling and damages the joints. Most patients are not receiving the essential low-cost medications and not having adequate disease control. Controlling disease activity can prevent the development of deformities and allows the person to lead a near normal life. International treatment guidelines recommend that patients should receive early and aggressive treatment for rheumatoid arthritis with medications. They are called Disease Modifying Anti-Rheumatic Drugs (DMARD) and have long been available. The delay in initiation of treatment can lead on to damages in the cartilage and cause deformities. More over these drugs are with least side effects. More recently, new group of drugs called the biological agents are available for the patient who have failed on DMARD.

What is systemic Lupus erythematosus?

Lupus erythematosus is a name given to a collection of autoimmune diseases, in which the immune system becomes hyperactive and attacks normal, healthy tissues. Symptoms of these diseases can affect many different body systems, including joints, skin, kidneys, blood cells, heart and lungs. Although it can affect any part of the body starting from skin, joints, to major organs like kidney, heart, lungs and brain, it is not a must that all the organs are affected in every patient. Some patient has only skin and joint involvement, some others have kidney and brain involvement along with skin and joint. So, it can have wide variety of manifestations which vary from patient to patient. The symptoms depend on which are the organs affected. Common symptoms includes extreme fatigue (tiredness), painful or swollen joints, fever, anemia, swelling of feet, skin rash, sun- or light-sensitivity (photosensitivity), hair loss and mouth ulcers.

What is Spondyloarthropathy?

Spondyloarthropathies are another type of arthritis that is common in males, predominantly affects the spine (back bone/vertebrae) and large joints of the lower limb which includes disease like Ankylosing spondylitis, reactive arthritis, Psoriatic arthritis, IBD related arthritis and undifferentiated spondyloarthropathy. It causes inflammation of the spinal joints (vertebrae) that can lead to severe, chronic pain and discomfort. In the most advanced/severe cases this inflammation can lead to new bone formation in the spine, causing the spine to fuse in a fixed, immobile position, sometimes creating a forward-stooped posture. Effective treatment for the control of pain and physiotherapy for preserving the spinal movements are present.

What is gout?

Gout is a medical condition usually characterized by recurrent attacks of red, tender, hot, swollen joint. Gout was historically known as "the disease of kings" or "rich man's disease" but now it has become a part of metabolic syndrome. Gout usually presents with recurrent attack of arthritis (a red, tender, hot, swollen joint). The base of the big toe is affected most often, accounting for half of cases and other joints such as the heels, knees, wrists and fingers may also be affected. Joint pain usually begins over 2–4 hours and during the night. Other symptoms may rarely occur along with the joint pain, including fatigue and a high fever. Hyperuricemia is the underlying cause of gout. This can occur for a number of reasons, including diet, genetic predisposition or underexcretion of urate. Renal underexcretion of uric acid is the primary cause of hyperuricemia in about 90% of the cases and another 10% are due to increased production of uric acid.

When you should see a Rheumatologist?

If pain in the joints, muscles or bones is severe or lasts more than a few days or when a patient is having multiple organ system involvement like skin rash, arthritis, red eye, oral ulcers, non healing skin ulcers and additional pulmonary, cardiac, neurological or gastrointestinal involvement (2 or >2 organ system involvement at the onset or over a period of time). Many types of rheumatic diseases are not easy to find in the early stage, and you may need to see a specialist. Some Musculoskeletal problems respond best to treatment in the early stages of the disease. These diseases tend to be chronic (long term) and often change over time. Sometimes they get worse and sometimes they go away for a while and then return. Rheumatologist works closely with patients’ to find the problem and design a treatment plan.

Are there any special tests needed?

Yes, depending on the case. If physician is able to make a diagnosis clinically then very few relevant investigations may be required to confirm the diagnosis and to know the extent/severity of the diseases. But if diagnosis is not clear than physician may require more number of investigations and different investigation over time. These investigations may be done on blood or radiological ones. These are also needed sometimes for documentation and differentiate from other diseases.